| NPI | 1417696311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP035361) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1679247) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2026-04-03 |